October 2015 by San Francisco Marin Medical Society

SAN FRANCISCO MEDICINE J O U R NA L O F T H E S A N F R A N C I S C O M E D I CA L S O C I E T Y

POLITICS AND ADVOCACY IN MEDICINE The Audacity of Physicians Leading Reform Early Career Physicians: What Future Do They Imagine for Organized Medicine? SFMS Political Action Committee

Plus: SFMS Leadership Election Information and 2015 General Meeting Recap

VOL.88 NO.8 October 2015

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IN THIS ISSUE

SAN FRANCISCO MEDICINE

October 2015 Volume 88, Number 8

Politics and Advocacy in Medicine FEATURE ARTICLES

MONTHLY COLUMNS

11 Making a Difference: SFMS Political Action Committee George Fouras, MD

Membership Matters

15 Early Career Physicians Speak: What Future Do They Imagine for Organized Medicine?

President’s Message: The Audacity of Physicians Leading Reform Roger Eng, MD, MPH, FACS

13 Working on Our Behalf: The American Medical Association Rob Margolin, MD

19 Hiroshima Team Visit: Long-Term Evaluation of Nuclear Bomb Survivors

Editorial: Organized Medicine is More than Politics and Advocacy Gordon Fung, MD, PhD

36 Medical Community News 38 Upcoming Events

OF INTEREST 5 SFMS General Meeting Recap 35 ICD-10: Making the Transition Kimbelee Snyder

SFMS 2015 Leadership Election Information, pages 20 to 33

Editorial and Advertising Offices: 1003 A O’Reilly Ave. San Francisco, CA 94129 Phone: (415) 561-0850 Web: www.sfms.org

MEMBERSHIP MATTERS Activities and Actions of Interest to SFMS Members

ICD-10 Resources for SFMS Members The ICD-10 transition affects every part of the physician practice, from software upgrades, to patient registration and referrals, to clinical documentation and billing. Although the grace period for ICD-10 eases a giant burden, it still doesn’t delay the implementation deadline of October 1. The grace period means that for one year starting October 1, Medicare will not deny claims solely on the specificity of the ICD-10 diagnosis codes as long as the physician submits an ICD-10 code from an appropriate family of codes. In addition, Medicare will not audit claims based on the specificity of the diagnosis codes as long as they are from the appropriate family of codes. SFMS has developed an overview and list of resources— including information for physicians that cannot make the transition deadline—for San Francisco physicians on page 35 of this issue and at http://www.sfms.org/for-physicians/icd-10.aspx.

Save the Date: SFMS Career Fair on November 17

Calling all residents, fellows, and employers! SFMS will be hosting its sixth annual Career Fair on November 17 at St. Mary’s Medical Center. The event runs from 5:00 p.m. until 8:00 p.m. and is complimentary to residents and fellows from the four San Francisco-based residency programs as well as SFMS physician members. This is an excellent opportunity for physicians looking to practice in the Bay Area to network with representatives from a variety of practice types and settings, and for employers to connect with physician job seekers. As part of an effort to make participation accessible to all, we are offering a tiered pricing structure for employers, with complimentary or discounted pricing for SFMS members. For event details or to inquire about exhibiting, contact the Membership Department at (415) 561-0850 or visit www.sfms.org/ Membership/StudentResidents.aspx.

Anthem Blue Cross Announces Incentive for Completion of Health Assessments

Anthem Blue Cross has announced provision of financial incentives to physicians for completing member health assessments for patients with certain exchange/mirror products effective June 1, 2015. Anthem is working with Inovalon to contact physicians to request completion of the health assessments. The assessments will be completed using Inovalon’s secure, electronic tool (ePASS) or using the Encounter Subjective, Objective, Assessment and Plan (SOAP) Note provided with by Inovalon for each identified patient. Physician are eligible to receive $100 for each properly submitted electronic SOAP note submitted through ePASS, or $50 for each properly submitted SOAP to Inovolan via secured fax. There are no penalties for non-compliance at this time. 4

Physicians who have questions regarding the program are asked to contact Anthem Provider Services at (855) 854-1438.

Blue Shield Announces Changes in Physician Fee Schedule

Blue Shield has announced changes to its physician fee schedule that will take effect November 1, 2015. The insurer said that it would be increasing payment for the more commonly billed office visit codes, including 99204, 99205, 99213, and 99214. The new rates will be available on the Blue Shield website beginning September 1. Physicians can also request a copy of the new fees by completing the allowance review form enclosed with the notice, or by calling the Blue Shield Provider Services Department at (800) 258-3091. SFMS/CMA is encouraging all physicians to carefully review all proposed amendments to health plan or medical group/IPA contracts. Physicians do not have to accept substandard contracts that are not beneficial to their practices.

SFMS/CMA Defeats AB 533

SFMS and the California Medical Association have defeated a bill that would have drastically changed the current health care marketplace by allowing a massive transfer of negotiating power to the health plans at the expense of physicians. AB 533 was an attempt to shield patients from billing disputes between providers and health plans and would have required non-contracted physicians and dentists to accept Medicare rates as payment in full when performing services in a contracted or “in-network” facility. Although SFMS/CMA is in favor of removing patients from billing disputes between health plans and out-of-network physicians, this specific solution would have transferred far too much power to health plans. If physicians were required to accept Medicare rates, the plans would have no motivation to contract with physicians. This would have eliminated physicians’ abilities to negotiate fair contracts and payment rates, reduced patient access to specialists, and incentivized plans to maintain narrower networks without any punishment for failing to maintain adequate networks. SFMS/CMA fought the measure to the end, rallying physicians and lobbying against it until a final vote was taken at midnight on the last day of the legislative session. Ultimately, the bill did not receive enough votes to advance.

Renew Your Commitment to Medicine; Renew Your SFMS Membership Today

2015 membership renewals are right around the corner! Make sure you continue to receive the benefits of SFMS and CMA by renewing your membership. There are three easy ways to renew your dues again this year:

SAN FRANCISCO MEDICINE OCTOBER 2015 WWW.SFMS.ORG

• Mail/fax in your completed renewal form when you receive it in the mail; • Renew online at www.sfms.org with your credit card; or • Enroll in the Easy Pay (quarterly installments) Automatic Dues Renewal Plan by contacting SFMS at (415) 561-0850 or membership@ sfms.org.

SFMS Member Appointed Newest San Francisco Health Commissioner

Stephen Follansbee, MD, a SFMS member and retired HIV and infectious diseases specialist, was appointed and sworn in as a member of the San Francisco Health Service System Board by Mayor Ed Lee. The Health Service System Board oversees all activities of the Health Services System, administering health benefits for more than 111,000 people, including employees of the City & County of San Francisco, the San Francisco Unified School District, the San Francisco Community College District, and San Francisco Superior Court. The board ensures eligible members and dependents have access to quality health care. Dr. Follansbee’s nomination was strongly endorsed by the SFMS. Follansbee, former Director of HIV Services at Kaiser San Francisco and recipient of the 2013 UCSF Associate Clinical Faculty Special Recognition Award, has been a past president and delegation chair of the SFMS, among many other positions and contributions.

SFMS Spotlights Community Health Efforts at General Meeting

A wonderful time was had by all at the September SFMS General Meeting at the Golden Gate Yacht Club. With warm enthusiasm, SFMS President Roger Eng, MD welcomed local physicians to the annual event. Featured speaker Assemblymember David Chiu provided an enlightening update on the state of health care at the Capitol, and acknowledged SFMS’ successful advocacy on several key legislations including vaccination and physicianassisted dying. Visit the SFMS Facebook or Flickr page for more photos from the General Meeting.

October 2015 Volume 88, Number 8 Editor Gordon Fung, MD, PhD Managing Editor Amanda Denz, MA EDITORIAL BOARD Editor Gordon Fung, MD, PhD Obituarist Erica Goode, MD, MPH Michel Accad, MD Erica Goode, MD, MPH Stephen Askin, MD Shieva Khayam-Bashi, MD Payal Bhandari, MD Arthur Lyons, MD Toni Brayer, MD John Maa, MD Chunbo Cai, MD David Pating, MD Linda Hawes Clever, MD

SFMS OFFICERS President Roger S. Eng, MD President-Elect Richard A. Podolin, MD Secretary Kimberly L. Newell, MD Treasurer Man-Kit Leung, MD Immediate Past President Lawrence Cheung, MD SFMS STAFF Executive Director and CEO Mary Lou Licwinko, JD, MHSA Associate Executive Director, Public Health and Education Steve Heilig, MPH Associate Executive Director, Membership and Marketing Jessica Kuo, MBA Director of Administration Posi Lyon Membership Coordinator Ariel Young

BOARD OF DIRECTORS Term: Jan 2015-Dec 2017 Steven H. Fugaro, MD Brian Grady, MD John Maa, MD Todd A. May, MD Stephanie Oltmann, MD William T. Prey, MD Michael C. Schrader, MD

Term: Jan 2013-Dec 2015 Charles E. Binkley, MD Gary L. Chan, MD Katherine E. Herz, MD David R. Pating, MD Cynthia A. Point, MD Lisa W. Tang, MD Joseph Woo, MD

Term: Jan 2014-Dec 2016 William J. Black, MD Benjamin C.K. Lau, MD Ingrid T. Lim, MD Keith E. Loring, MD Ryan Padrez, MD Rachel H.C. Shu, MD Paul J. Turek, MD CMA Trustee Shannon Udovic-Constant, MD AMA Delegate Robert J. Margolin, MD AMA Alternate Gordon L. Fung, MD, PhD

WWW.SFMS.ORG

OCTOBER 2015 SAN FRANCISCO MEDICINE

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PRESIDENT’S MESSAGE Roger S. Eng, MD, MPH, FACR

The Audacity of Physicians Leading Reform These days it seems like the medical profession is being assaulted from all corners. Those in my community have referred to the twin pillars of EHR and now ICD-10 adoption as the one-two knockout punch for the traditional medical practice. There has been a shift in health care where physicians are asked to maximize reimbursement for the practice or hospital instead of focusing on patient care. The aim to provide accessible, quality care has been high jacked by the financing arm of the health care industry to generate better profit margins. I have sat through many ICD-10 training sessions where the main emphasis was around how to maneuver through the hoops to get paid. Numerous health care mandates—the fluctuating requirements of meaningful use (MU), the transition to ICD-10, and the ongoing shift from volume-based to value-based care—coupled with the health care marketplace’s growing reliance on physician extenders to deliver care, are stretching physicians to the breaking point. With declining reimbursement, increasing non-clinical workload, and expansion of scope of practice for mid-level practitioners, is our profession heading for irrevocable decline? Physicians need to initiate the conversation to affect positive change in health care reform.

1. Make EHRs work for physicians and patients.

There are significant usability challenges when it comes to EHR implementation and the delivery of quality care. More than 1,000 certified EHR systems meet MU requirements but there is no data liquidity. AMA and CMA working hard to change stage 3 MU to include more interoperability and ease of use requirements for doctors.

2. Finance system that rewards real value.

Dissociate ICD-10 from physician payment. ICD-10 is used by European nations for research and population analysis, and not as payment mechanism. Research suggests ICD-10 may add 5 to 25% more time/cost to administration of billing without improving health care outcomes.

3. Establish standards and policies that foster innovation.

Innovation has been a mantra by government entities since the enactment of the Affordable Care Act (ACA). Yet, largely this effort has been disjointed and haphazard. It’s time for more organized analysis of how to dole out innovation funding with physicians at the table to lead.

WWW.SFMS.ORG

4. Lower barriers to integration from bottom up. CMS can and should be the convener of parties to build up a secure open standard digital record superhighway. Once accomplished, the government can serve as the regulatory referee to ensure interoperability compliance from vendors, payors, and delivery organizations.

5. Level the playing field.

No one reading this article would ever think a few doctors in a room would have the same power and influence on health care pricing as Carnegie, Mellon, and Rockefeller did for the steel industry. Think how much say you have with the thirtyfive-page agreements health plans send you. Yet, that is the exact situation the government looks at us when it comes to our practices when it comes to financing. Eliminating the Sherman antitrust act on physicians will open up opportunities for MD empowerment in how we practice.

6. Make ACA work better.

A key priority at this year’s House of Delegates meeting is to foster discussions of strategies to improve Covered CA and ensure quality care delivery. Organized medicine knows there is more than one way to provide health care. Diversity in our health care delivery models is a key component to better meeting the triple aim of enhancing patient experience, improving population health, and reducing costs. The physician voice is amplified through participation in our local, state, and national societies. In this month’s issue, you will see the dozens of physician members who are not only support our profession through their membership, but also donate their time serving on your Board and other leadership roles. If you see them in the hallway of your local clinic or hospital, please give them a thanks for serving. Connect with Dr. Eng via Twitter @RogerEngMD or send him an email at reng@sfms.org.

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EDITORIAL Gordon Fung, MD, PhD

Organized Medicine is More Than Politics and Advocacy When the editorial board began brainstorming for this issue the definition of “organized medicine” came into question. The exact definition eluded us as several people in the room had differing opinions as to what is and isn’t organized medicine. Does this term refer to medical societies banding together to advocate for physicians, or does it refer to large hospitals bringing together many physicians as a staff, or does it refer to independent practice associations for physicians practicing in the community? We all agreed that organized medicine does refer to some institution gathering physicians from all modes of practice and levels of training to optimize high quality healthcare for the communities they serve. After the meeting, I Googled the term. Surprisingly, there is no formal definition in the Internet. The top hit was a term from a medical sociology site. It stated, “organized medicine remains one of the most powerful social institutions in modern times”. However, it seems a true definition of organized medicine is hard to come by. In my eyes, organized medicine is simply the organization of the medical profession as a whole. The cohesive structure of the medical profession as an organized group then becomes an “interest group” through which they can elicit a powerful organized voice and affect policies and procedures in both a social and professional group sense. It is very much like the concept of organized labor but involves medical professionals instead of laborers. Why is this topic so important that we decided to devote an entire issue of San Francisco Medicine to it? The SFMS is often asked by physicians, “what does organized medicine do for me and my patients?” The answer requires a look at the historical development of state medical societies that started over 230 years ago. The oldest state medical society in America is the Massachusetts Medical Society that was established in 1781 just days after the Revolutionary War. The medical society was delegated the duty of licensing physicians and in 1842 it also took on the duties of spearheading the department of public health. SFMS began in 1853 and the CMA in 1856. One of their initial duties was to weed out charlatans from formally educated physicians. At the time there was no governmental involvement in health care. These were the humble beginnings of organized medicine. Over time with increasing governmental involvement in reimbursements, regulations, certification, and the changing modes of practice, organized medicine has expanded to help WWW.SFMS.ORG

shape the rules physicians must practice by and also to help physicians navigate those complicated waters. The biggest organization of physicians is the American Medical Association with its affiliations with all state medical associations and representation of all of the certified specialty societies. The AMA and specific organizations such as Joint commission of accreditation of hospitals, the American Board of Specialty Societies, the American College of Surgeons, the American College of physicians etc. with up to forty separate organizations represented make up the actual institution of organized medicine. When someone asks, “What does organized medicine do for me?” I respond with the most highly visible and notable political battles that preserve access of high quality care such as the protection of MICRA, the complete elimination of the SGR (sustainable growth rate – formula for Medicare Reimbursement), the push for vaccinations of school aged children with limited exemptions, the increase in taxes on tobacco products, establishing CPR training as a requirement for high school graduation. These are big recent victories, but organized medicine has been behind these issues for decades—educating governmental officials, agencies, and regulatory bodies and promoting policies or laws improve health and wellbeing. My bottom-line response is that organized medicine is always working to create the best environment to practice medicine—whether the focus is medical care, public health, or emergency health care. We are persistent, determined, and principled. We identify problems and fix them. In this issue, you will read about that work and I hope it will inspire you to stay involved with organized medicine as it continues to grow, responding to new and changing needs of physicians and patients.

OCTOBER 2015 SAN FRANCISCO MEDICINE

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Politics and Advocacy in Medicine

MAKING A DIFFERENCE SFMS Political Action Committee George Fouras, MD The SFMS Political Action Committee (PAC) exists to advocate for political candidates who share our beliefs regard-

ing issues of medicine and public health, including support for propositions and other legislative issues supporting the overall mission of the SFMS. We are able to do this from donations that we receive from the members of the SFMS and other interested people. We also work in tandem with the CMA’s CALPAC in support of local candidates or for statewide issues which impact public health in San Francisco The PAC is thus part of the SFMS, yet is distinct with its own set of bylaws and a board of directors. Members of the Board come from the current Board of the SFMS and other general members. Any member of the SFMS is welcome to participate and to attend our meetings, which most often precede the general SFMS board meeting. One of our biggest recent achievements, in collaboration with CMA, was the defeat of Proposition 46, which would have dramatically changed MICRA—and thus your liability insurance and access to care—for the worse. The campaign mounted by organized medicine resulted in a landslide vote against this deceptive proposal. Locally we worked very hard on this. Historically, SFMS has not endorsed any one candidate for office. However, Assemblyman David Chiu took an unprecedented position in support of MICRA early on during his campaign, and the SFMS PAC made the decision to endorse his campaign. Mr. Chiu won a very tight race for the Assembly seat previously held by Tom Ammiano. Chiu’s opponent, David Campos, was supported by the trial attorneys who were also promoting Proposition 46. We also supported the re-election campaign of state Senator Dr. Richard Pan, a practicing pediatrician in the Davis area, in another very tight race. Once elected, in collaboration with CMA, we joined him in advocating for a change in state vaccination policy to restrict the ability for “personal belief” exemptions. As a result of the success of Dr. Pan’s legislation on vaccination exemption reform, it has been suggested that a recall campaign may be initiated. SFMS will be monitoring closely, and will support Dr. Pan if necessary, but we hope and expect this will not become necessary. San Francisco Supervisor Scott Weiner has been a champion of public health issues in San Francisco, a supporter of MICRA and a chief supporter of our efforts in reducing the consumption of soda products via a “Soda Tax”. The SFMS PAC has made the decision to endorse Mr. Weiner in his campaign for the Senate seat held by Mark Leno, who is now termed out of office. Every two years, we host a “candidate’s night” as part of the election cycle where half of the Supervisorial seats are up for grabs. We invite promising candidates to come to the SFMS offices where members interview the candidates and decide WWW.SFMS.ORG

whether and at what level of support to fund them. We only endorse candidates for office in rare cases, but let the candidates know we are available to them as a resource and to foster a positive relationship. For this election cycle, we will not be hosting the candidate’s night as there were few races with serious challenges. In addition, we are actively supporting the re-election campaign of Mayor Ed Lee.

Why—And How—To Get Involved

Doctors have never been more vulnerable. Health care in California is highly regulated and legislated. As government and the insurance industry continue their quest to control health care, your clinical autonomy is in jeopardy. Now more than ever, you need to fight to keep medical decisions in your well-trained hands. Medicine continues to face big challenges from budget deficits, implementation of health care reform, and attacks on MICRA and Medi-Cal. At the same time, the health of San Franciscans faces multiple risks from the economy, the insurance industry, and the health care delivery system. The voice of medicine must be heard on these issues. SFMS PAC is an essential and critical part of SFMS’ legislative and political advocacy efforts, because it gives physicians a tangible means to support candidates who share our goals at the local and state levels. We are the voice of San Francisco physicians, and we need your support. The most important way for members to become involved would be to donate to the PAC. It is only through donations that we are able to do the work that we do. If you have more time, and are interested in meeting potential candidates, or have someone that you would like to show more support for, then attend a fundraiser. During elections years these are more common than not. Finally, for those who would like to be the most active, please consider joining the PAC board or attending our meetings. Questions? info@sfms.org or (415) 561-0850.

Dr. Fouras chairs the SFMS PAC board and is a past-president of the SFMS.

OCTOBER 2015 SAN FRANCISCO MEDICINE

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Politics and Advocacy in Medicine

WORKING ON OUR BEHALF The American Medical Association Rob Margolin, MD The interests of physicians and our patients are best served when we gather together, debate issues, come to consensus, and speak with one voice. The American Medical Association (AMA) continues to serve as the lone voice that speaks for all physicians, regardless of geography, mode of practice, or specialty. For the past ten years I have been fortunate to have served as your representative on the California delegation to the AMA. Recent issues that the AMA has successfully advanced on our behalf include the following: • Obtaining a one-year grace period for physicians having difficulty with implementing the new ICD-10 coding. During this time physicians will get paid even if their coding is imperfect. • Modifying electronic health records meaning use rules to make them less punitive and onerous. • Curbing the rising costs of generic medications. • Declaring that obesity is a disease, thus increasing public awareness of its significance and promoting plans to reduce its prevalence. • Improving the very narrow physician networks found in to many of the Affordable Care Act (ACA) health plans. • Highlighting the dangers of health plan mergers which exceed federal antitrust guidelines and thus squeeze competition. • Attempting to modify the three day rule before patients can be transferred from a hospital to a skilled nursing facility. • Increasing funding for graduate medical education to address the inadequacy of residency positions for graduating medical students. Last year more than 1,000 graduates could not find residencies! Our small but politically powerful SFMS delegation is to be applauded for bringing many issues to the CMA House of Delegates in an effort to create a statewide consensus. Given the political diversity in our state, this often requires considerable perseverance and persuasiveness. Occasionally this will require bringing an issue back to the CMA House several times. When our resolutions are adopted and have relevance on a national level, our California delegation will then bring the resolution to the AMA. It is gratifying and empowering when an idea that germinated locally becomes a national call for action. Recent successes include the following: • End-of-Life: Our delegation brought a resolution to the CMA and AMA urging that Medicare payment codes for end-oflife counseling be created and reimbursed. Centers for Medicare & Medicaid Services (CMS) has now incorporated this into the upcoming fee schedule. Recently the AMA extended this discussion to include the creation of Medicare reimbursement codes for anticoagulant management, education and training for patient self-management, analysis of computer transmitted data, WWW.SFMS.ORG

and complex chronic care management services. This will better match payments to the way physicians practice in the real world. • Antibiotics: After hosting a national conference on the problem of mass use of antibiotics in agriculture, our Medical Society developed a resolution to curtail this. This was approved by the CMA and then the AMA. There has been legislation proposed on the topic and we are hopeful this will pass. • Needle Exchange: AMA has passed a resolution, originally proposed by our delegation, supporting the legalization of needle exchange programs to interrupt HIV transmission. • Free Speech: San Francisco resolutions, adopted by the AMA, include the rescinding of free speech restrictions on physicians discussing gun safety and abortion options with patients. • Undocumented Immigrants: In too many instances, hospitals were inappropriately discharging and deporting immigrants who were still quite ill but for whom they were not receiving reimbursement. Our delegation brought this to the AMA, resulting in a report from the AMA’s Council on Ethical and Judicial Affairs castigating this practice and empowering physicians to stand up to hospital administrators who were pressuring them to act against their medical judgment. • Tobacco Tax: Our delegation has been active in promoting increased taxes on tobacco products and was one of the first to bring this to the CMA and AMA. Organized Medicine now stands united in advocating for this important tool that save lives. Recently we have been active in pushing the AMA to support the regulation of electronic cigarettes. I know that many physicians are suffering as they see medicine changing in ways they can’t control. But any member of our medical society can bring an idea for a resolution to our delegation. If you have a concern about aspects of medical care that you want changed, please let us know. Working together, we can make a difference.

Rob Margolin has been an SFMS member for thirty years. He is a past president, a recent CMA trustee, and our current delegate to the AMA. He practices primary care medicine and is vice chief of staff at CPMC. Contact membership@sfms.org with questions or resolution ideas for the delegation.

OCTOBER 2015 SAN FRANCISCO MEDICINE

s ce L S i t a ER isco prac C l Lo Loyn FraMnecdica a d p g S an n i s EMFeatusr pital o

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Level C Morrissey Hall, St. Mary’s Medical Center 2250 Hayes Street, San Francisco Refreshments and hors d’oeuvres provided by the SFMS

For detailed event information, including a list of confirmed exhibitors, please visit http://www.sfms.org/Membership/StudentResidents.aspx

EvEnt opEn to aLL UCSF, CpMC, St. MaRy’S, and KaiSER pERManEntE SF RESidEntS and FELLowS

Politics and Advocacy in Medicine

EARLY CAREER PHYSICIANS SPEAK What Future Do They Imagine For Organized Medicine?

This month San Francisco Medicine asked young doctors the question: “What would you like to see organized medicine do for your generation of physicians?” We’ve collected replies here. “Redefining healthcare is in vogue. It is happening all around us in terms of healthcare delivery (office visits versus telemedicine), healthcare finance (fee-for-service versus value-based care), and even the basic definition of what constitutes care (history and physical exam versus download of data from a smart-phone with computer-based analysis, diagnosis, and care-plan generation). I envision future organized medicine bringing doctors together as doctors, providing the infrastructure to enable easy collaboration and connectivity to advance patient care as doctors. Although every physician’s skillset is unique and provides a special frame of reference through which the world of medicine is viewed, our identity as physicians should transcend our specialty societies and the institutions in which we work. Through further development of physician leadership tracks, information-sharing infrastructure geared towards physicians, and physician-led health policy think-tanks, organized medicine could contribute to the new and evolving definition of healthcare, maintaining the core of its meaning as a physician caring for a patient. I would like to see organized medicine provide a common, non-competitive foundation on which all physicians could stand and direct the redefinition of healthcare rather than react in a diluted manner through a variety of healthcare delivery systems, specialty societies, and private entities. Benjamin Franc, MD, MS, professor in the department of Radiology and Biomedical Imaging at UCSF.

— “When I started my first day of medical school more than ten years ago, I was mentally and emotionally prepared for a long but exciting journey ahead of lifelong education, training, and then even more training. I remember sitting in a room on my first day with 31 of my peers, all similarly ambitious, at the top of our class, and eager to become the next leaders in medicine. As I reflect now as a young practicing ophthalmologist in the “real world”, I often ask myself how the reality of practicing medicine now could differ so drastically from the quixotic (and perhaps naïve) expectations of medical practice I had in the past. This exercise of self-reflection forced me to reconcile the immense joy I have in helping patients protect and preserve their eyesight with the dissatisfying aspects of running a practice which is constantly stymied by the pressures of regulatory compliance. We physicians are now bombarded by increasingly stringent regulaWWW.SFMS.ORG

tions by which we must comply, or else face penalties and reductions in reimbursement. The imminent ICD-10 coding overhaul, electronic health records, PQRS, and “Meaningful Use” programs are but a few of the major hurdles facing all physicians now. These government-mandated quality measures that were intended to improve healthcare are making medical practice for physicians daunting and financially difficult. As a result, many young physicians are forced to seek alternative positions as hospital employees. The dream of having a thriving, independent practice is being threatened by these compliance nightmares. Organized medicine should serve as a liaison and voice for those who hope to effect change on a broad level, but also importantly empower the young physicians who are just starting their practice. In turn, we must also play a more sentient role in lobbying our local, state, and national representatives for a model of care that reduces costs while maintaining high quality and physician satisfaction. I believe the future of our profession is not entirely bleak; however, we physicians must be our own advocates and be ourselves willing participants in organized medicine.” Kevin Tan, MD, MS, is CEO, eye physician, and surgeon at Eyecare Associates of San Francisco.

— “One of the great benefits of working within an integrated care model is the opportunity to work in and experience one of the premier organized health care systems in the country. The population management tools and access to specialists are hard to beat. With that being said, there is still room for improvement, especially in the usage of its primary care physicians. Specifically, I would like to see organized medicine standardize best practices that create attractive and sustainable careers for PCPs. Some of the best practices that I’d like to see implemented are: capped panel sizes, built in protected time for the new generation of “electronic” care of patients, more team-based care of patients, and most importantly, flexible patient scheduling that allows for longer appointments necessitated by new and/or complicated patients. Not only do patients get better results from these practices, but doctors receive greater satisfaction from the ability to better care for each patient. Ultimately, the development of sustainable, fulfilling careers will help attract the best and brightest graduates into primary care. It’s my hope that more of today’s leaders will seek out and take advantage of the wealth of experiences that you and I have, along with the fresh perspectives we offer. Let’s bring these best practices to organized medicine and make it the new standard of care.”

Continued on page 15 . . .

OCTOBER 2015 SAN FRANCISCO MEDICINE

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Early Career Physicians Speak Continued from page 13 . . . Elizabeth (Libby) Schaefer, MD, is an internal medicine and pediatrics physician at Kaiser Permanente, San Francisco.

— “Physicians have traditionally been an independent breed. A standard cliché among past generations is that you go to medical school partly to become the “captain of your own ship.” All of that is changing. Very few residency graduates are starting their own practices, and the number joining private practices is shrinking. Many are becoming salaried employees of large medical groups or health care organizations. This may say something about the changing landscape of health care in America. In private practice, the clinical staff, the physicians, the operations staff, and the financial staff are all woven together as one system. In a large health organization, the clinical, operational, and financial are separate realms, each with its own language and processes. Three elements that will be crucial within this model is authentic collaboration through teamwork, leadership and effective communication. It is imperative that the physician challenge each member of the health care team to perform at the highest level of their abilities. The most effective way to perform this task is by way of professional leadership and communication. Nobel Peace Prize laureate Albert Schweitzer offered this advice: “I don’t know what your destiny will be but this much I do know: the only ones among you who will be truly happy are those who have sought and found how to serve.” Curtis P. Ross, DO, is a minimally invasive urologic surgeon and general urologist in private practice in San Francisco.

— “I initially got involved in organized medicine as a first-year medical student in order to better advocate for my patients. Throughout the past several years I have come to find that it is not just our patients in need of serious advocacy but us, as physicians, need this support more than ever. What I would like to see organized medicine do for my generation of physicians is better demonstrate its value. As my peers encounter newfound challenges upon entering the workforce it is up to our organizations to clearly demonstrate how they have supported us in these endeavors and what they can do for us in the near future. This includes local scope-of-practice battles which intimately affect not only our job prospects but our job functions. Group-advocacy, career advisement, and contract negotiation assistance will be more important to us than ever as my generation becomes increasingly more employed (vs. self-employed). In many instances we are transitioning to a role of employee without a union which may provide organizations such as the CMA and SFMS a great opportunity to become our advocates. In today’s health care system climate we need a centralized voice that cuts through the noise and accomplishes real-world, tangible goals. More importantly, we need to adapt our organizations media and PR initiatives to assure that every young WWW.SFMS.ORG

physician within our organizations regional jurisdiction are made aware of these efforts in order to improve recruitment and retention. Without demonstrating the value of organized medicine to my generation of physicians, they will have no incentive to participate. Unfortunately, many of them have no idea how much incredible work is done annually on their behalf- I say we let them know.” Michael C. Lubrano, MD, MPH, is a PGY-2 in the department of Anesthesia & Perioperative Care at the University of California San Francisco Medical Center. He is also chair of the CMA Residents and Fellow Section.

GOVERNOR BROWN SIGNS “ASSISTED DYING” BILL California has just become the sixth state to legalize physicianassisted dying, after many previous failed efforts. In signing the bill which becomes law January 1, Brown noted in a very personal letter:

October 5, 2015 | To members of the California State Assembly, ABx2 is not an ordinary bill because it deals with life and death. The crux of the matter is whether the State of California should continue to make it a crime for a dying person to end his life, no matter how great his pain and suffering. I have carefully read the thoughtful opposition materials presented by a number of doctors, religious leaders, and those who champion disability rights. I have considered the theological and religious perspectives that any deliberate shortening of one’s life is sinful. I have also read the letter so those who support the bill, including heartfelt pleas from Brittany Maynard’s family, the Archbishop Desmond Tutu. In addition, I have discussed the matter with a Catholic Bishop, two of my own doctors and former classmates and friends who take varied, contradictory and nuanced positions. In the end, I was left to reflect on what I would want in the face of my own death. I do not know what I would do if I were dying in prolonged and excruciating pain. I am certain, however, that it would be a comfort to be able to consider the options afforded by this bill. And I wouldn’t deny that right to others. Sincerely, Edmund G. Brown, Jr. The San Francisco Medical Society wishes to publicly thank Governor Jerry Brown for signing into law the End-of-Life Option act. His moving personal message conveys how difficult and controversial the issue of “physician-assisted dying’” can be. Although most medical groups have historically opposed this practice, our organization studied it intensively last year and, citing both surveys of physician opinion and the reassuring evidence from other states, successfully advocated that the California Medical Association become neutral on the bill and topic, thus allowing the legislation to reach Governor Brown. We will continue to work for improved endof-life care and patient choice, and feel that this bill will advance those goals for all Californians. Roger Eng, MD | SFMS President

OCTOBER 2015 SAN FRANCISCO MEDICINE

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Politics and Advocacy in Medicine

HIROSHIMA TEAM VISIT Long-Term Evaluation of Nuclear Bomb Survivors

SFMS again hosted a reception to welcome and thank the team from the Hiroshima Prefectural Medical Association (HPMA) for once again conducting

medical examinations in San Francisco for local “hibakusha”— survivors of the atomic bombings of Hiroshima and Nagasaki. As the sister society to HPMA since 1981, SFMS has provided the local affiliation necessary for the team of HPMA physicians to conduct these medical examinations when they visit every other year. Since 1977, the Hiroshima Prefectural Medical Association has sponsored official biennial medical missions for the benefit of hibakusha and their children living in the United States who, due to the survivors’ exposure to radiation in the 1945 bombings, might face continuing medical problems. This year, the team members who made the long trek from Japan to San Francisco were Masao Kuwabara, MD, PhD, (Team Leader); Daisuke Haruta, MD, PhD, Jun Noma, MD, PhD, Masakazu Yamasaki, MD, PhD, Norie Ichiku and Kazuko Kamigochi, HPMA staff. The health examinations cover clinical examinations for internal diseases as well as surgical and gynecological physical examinations and consultations. Included in the examinations are the following: general hematology tests, urinalysis, biochemical testing such as liver function tests, diabetes screening, thyroid gland function testing, serum cholesterol as well as screenings for colorectal cancer, liver cancer, multiple myeloma, breast cancer, and uterine cancer. The team issues a report after each visit. Noting that the Japan bombings were one-time, albeit massive, exposure, so far the results are encouraging—other than longstanding anxiety and other psychological impacts, there have been few statistically significant physical impacts detected. The medical examinations were held at St. Mary’s Medical Center, which, along with the Sister Mary Philippa Health Center, has been involved with the biennial medical mission since 1995.

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OCTOBER 2015 SAN FRANCISCO MEDICINE

SLATE OF CANDIDATES SFMS 2015 Election Pursuant to the San Francisco Medical Society Bylaws “Article X Section 2 - Nominations” the Nominations Committee renders in writing the following slate of candidates for the 2015 SFMS election. This slate was read at the September 14, 2015 General Meeting, at which time the SFMS President called for additional nominations from the floor.

2016 Officers | Term 2016

For SFMS President-Elect Man-Kit Leung, MD For SFMS Secretary John Maa, MD For SFMS Treasurer Kimberly L. Newell, MD For SFMS Editor Gordon L. Fung, MD, PhD, FACC, FACP (Incumbent Editor)

SFMS Board of Directors

Term: 2016-2018 Seven candidates to be elected to the SFMS Board of Directors: Charles E. Binkley, MD (Incumbent Director) Nida F. Degesys, MD Benjamin L. Franc, MD, MS Katherine E. Herz, MD, MS (Incumbent Director) Jerry Y. Jew, MD, MBA Todd A. LeVine, MD, MS Raymond Liu, MD Heyman Oo, MD, MPH David R. Pating, MD (Incumbent Director) Monique D. Schaulis, MD, MPH Kory D. Stotesbery, DO Winnie Tong, MD

SFMS Nominations Committee

Term: 2016-2017 Four candidates to be elected to the SFMS Nominations Committee: Mabel A. Chan, MD Alice Hm Chen, MD David T. Duong, MD, PhD Fung Lam, MD Dawn D. Ogawa, MD

American Medical Association Delegate Term 2016-2017 Robert J. Margolin, MD (Incumbent Delegate)

American Medical Association Alternate Delegate

SFMS Young Physicians Section (YPS) Delegate and Alternate to the California Medical Association House of Delegates Term: 2016-2017 The candidate with the highest number of votes will serve as Delegate; the candidate with the next highest number of votes will serve as Alternate Delegate: Mark A. Schrumpf, MD Kory D. Stotesbery, DO Shoshana R. Ungerleider, MD (Incumbent Alternate)

SFMS Delegation to the California Medical Association House of Delegates

Term: 2016-2017 The candidates receiving the highest number of votes will serve as Delegates; the rest will be Alternate Delegates or on the wait list. The President-Elect automatically becomes one of the Delegates according to the SFMS Bylaws: Ameena T. Ahmed, MD, MPH (Incumbent Delegate) Charles E. Binkley, MD Roger S. Eng, MD, MPH, FACR (Incumbent Delegate) George A. Fouras, MD (Incumbent Delegate) Brian Grady, MD Katherine E. Herz, MD, MS (Incumbent Delegate) Sindhura Kodali, MD, MPH Keith E. Loring, MD (Incumbent Alternate) Stephanie Oltmann, MD Judy L. Silverman, MD (Incumbent Alternate) Daria L. Thompson, MD, MPH

Term 2016-2017 Gordon L. Fung, MD, PhD, FACC, FACP (Incumbent Alternate)

NOTES

2015 President-Elect, Richard A. Podolin, MD, FACC, automatically succeeds to the office of President. 2015 President, Roger S. Eng, MD, MPH, FACR, automatically succeeds to the office of Immediate Past President.

Member voting will take place ONLINE ONLY. In order to place your vote, we must have your email address in our database. Please provide us with your email address if we don’t already have it. Paper ballots are NO LONGER mailed. Please look for a special email from SFMS on October 19 with detailed information regarding the online voting process, as well as the link to the online ballot.

Your email vote must be cast by 5 p.m. on Monday, November 9, 2015. Please see candidate biographies and statements on the following pages.

SAN FRANCISCO MEDICINE OCTOBER 2015 WWW.SFMS.ORG

CANDIDATE BIOGRAPHIES President-Elect

Secretary

KIMBERLY L. NEWELL, MD

JOHN MAA, MD

MAN-KIT LEUNG, MD

Otolaryngology

Treasurer

General Surgery

Pediatrics

Current Job Positions and Hospital and Teaching Affiliations

Private practice in small group; affiliations with Chinese Hospital, St. Francis Memorial Hospital, CPMC, St. Mary’s Medical Center; Adjunct Clinical Instructor, Stanford University School of Medicine Department of Otolaryngology – Head & Neck Surgery. SFMS/CMA Committees or Offices

Treasurer; Secretary, Board of Directors, Executive Committee, PAC (former Vice Chair), Nominations Committee, Chinese Hospital liaison to SFMS; CMA: Alternate Delegate to HOD, CMA At-Large Delegate to Council on Legislation. Additional Relevant Experience

St. Francis Memorial Hospital Board of Trustees.

Why Are You Interested in Serving?

It is a great honor to be nominated for President-Elect of SFMS. Having been an SFMS officer for the past three years, I hope to build upon the successes of others before me to advance our shared goals: to advocate for physician and patient rights, to improve health care for all, and to support the well-being of all modes of physician practices.

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1) Chair, UC Office of the President Tobacco Related Disease Research Program. 2) Marin General Hospital, General and Trauma Surgery. 3) Chair of the American Heart Association Western States Affiliate Advocacy Committee. Selected as (415) Top Doctor by Marin Magazine and as a San Francisco SuperDoctor in 2012 and 2013.

Pediatrician, Kaiser Permanente; Assistant Clinical Professor, UCSF.

Board of Directors 2012 - present; Executive Committee 2014-15/2012-13; AMA 1991 to present; CMA Specialty Society Delegate Northern California Chapter of the American College of Surgeons (ACS); Awarded SFMS David Perlman Award for Excellence in Medical Journalism in 2013; San Francisco Medicine Magazine Editorial Board 2012 to present.

Secretary 2015, SFMS: Board of Directors 2012-2014, Executive Committee 2014-present, Nominations Committee 2010-11.

Past President, ACS Northern California Chapter; Recipient of the 2013 ACS Ellenberger Award for Excellence in State Advocacy; Nominated for the White House “Champion of Change for Prevention and Public Health” 2013; Named one of “Top 20 people making a difference in healthcare in America” 2009; Current Member of American Heart Association Board of Directors and Past President, San Mateo Division 2004-2005; Commendation for Tobacco Control Advocacy by the SF Board of Supervisors in 2014.

Having trained at UCSF, worked in the community at SFGH and at several private practice offices, and now being in practice at Kaiser San Francisco, I have had experience with a range of medical settings and care delivery systems in this city. I have held several local and regional leadership positions at Kaiser Permanente, including Chief Healthcare Innovation Office, Chief of Physician Health and Wellness, Emerging Leaders Program, Department Technology Lead, and CME Coordinator.

As Secretary-Treasurer of the ACS Chapter, I secured donations and grant funding to expand programs for Members and advocate on behalf of quality patient care in Sacramento. I would be honored to help SFMS lead efforts to strengthen the future practice of medicine, and improve the health of San Francisco.

More than ever in these turbulent times, physicians must work to shape how medicine evolves so we can continue to take exemplary care of our patients and attain professional satisfaction. I would be honored to continue to help lead this group of committed physician leaders for the benefit of the entire community.

OCTOBER 2015 SAN FRANCISCO MEDICINE

CANDIDATE BIOGRAPHIES Board of Directors

Editor

CHARLES E. BINKLEY, MD

GORDON FUNG, MD, PHD, FACC, FACP

NIDA F. DEGESYS, MD

Incumbent Director

Incumbent Editor

Also Candidate for AMA Delegation

Cardiology

Also Candidate for CMA Delegation

Surgery—Hepatobiliary and Pancreatic

Emergency Medicine

Current Job Positions and Hospital and Teaching Affiliations

Clinical Professor of Medicine, UCSF Medical Center; Director of Cardiac Services at UCSF Medical Center at Mount Zion; Director of Asian Heart & Vascular Center; Director of Electrocardiography Laboratory at Moffitt-Long Hospital.

Attending Surgeon, Kaiser Permanente Medical Center, San Francisco; Clinical Surgical Faculty, UCSF.

Resident Physician, University of California San Francisco/San Francisco General Hospital.

SFMS Board of Directors 2013-2015; CMA Council on Ethical Affairs since 2013.

None

I currently serve as Vice President/President Elect of the Professional Medical Staff at Kaiser Permanente Medical Center in San Francisco. I also chair the Medical Center Ethics Committee. In my previous post at Kaiser Permanente Hayward Medical Center, I was a member of the Credentials Committee and Assistant Chief of Surgery. I am also active in Bay Area Physicians for Human Rights.

I currently serve as the National Vice Speaker of the Emergency Medicine Residents’ Association, an organization of over 13,000 emergency medicine physicians-in-training. I served as the National President of the American Medical Student Association, where I represented over 35,000 physiciansin-training and chaired a board of 12 trustees. During medical school I was appointed by the Governor of Ohio to serve as a student trustee to the Northeast Ohio Medical University Board of Trustees.

SFMS/CMA Committees or Offices

Editor 2011 to present, Executive Committee 2011-present; Past President; CMA: Delegate since 2000 (Chair since 2014), Member of Council of Scientific Affairs 2004-present, IMQ Surveyor since 1994. Additional Relevant Experience

None

Why Are You Interested in Serving?

Communicating, educating, and learning are the jobs of an editor. Over the past five years I have learned so much about the topics and issues facing clinicians in practice in the community as well as academics. Working with the SFMS staff, Editorial Board, and Executive Committee and keeping the communication channels open with the membership and other interested parties that interface with SFMS through San Francisco Medicine has been one of the highlights of my involvement with SFMS. In a sense, San Francisco Medicine, our award-winning journal, is one of the oldest still-viable forms of social media used by the physician community serving San Francisco Bay Area. I truly cherish my time on the board and look forward to serving as your editor for 2016. 22

Why Are You Interested in Serving?

I believe that I can serve as an effective leader and advocate for San Francisco’s physicians. I am excited to continue to get to know and represent my colleagues and further strengthen the local medical community. I also look forward to better understanding and helping improve the health of the people of San Francisco.

Being new to San Francisco, I want to be more active in our community. It would be an honor to represent over 2,800 residents in the Bay Area and increase resident participation in SFMS and organized medicine and to encourage more resident driven advocacy on topics important to our patients’ health.

SAN FRANCISCO MEDICINE OCTOBER 2015 WWW.SFMS.ORG

JERRY Y. JEW, MD, MBA

KATHERINE E. HERZ, MD, MS

BENJAMIN L. FRANC, MD, MS

Incumbent Director

Also Candidate for Delegation

Nuclear Medicine / Molecular Imaging

General Pediatrics

Family Practice

Current Job Positions and Hospital and Teaching Affiliations

Professor, Department of Radiology and Biomedical Imaging, University of California, San Francisco. The majority of my time is dedicated to clinical duties, teaching, and administrative areas. My research spans the areas of molecular imaging, health policy and optimization of oncology care resource utilization.

The Permanente Medical Group, Kaiser San Francisco, Department of Pediatrics

I am the Medical Director at North East Medical Services (NEMS), a nonprofit community health center operating ten clinics throughout the San Francisco Bay Area. I am on the medical staff with Chinese Hospital.

SFMS Board Liaison to the UCSF Medical Staff. CMA – Member of the Council on Information Technology. PAST: Sierra Sacramento Valley Medical Society – Delegate to the CMA HOD; Member of the Medical Review and Advisory Committee. Washington D.C. AMA Student Section – Chair.

SFMS Board of Directors, 2013-15; Delegate, CMA House of Delegates, 2014-2015 (Alternate Delegate, 2012-2013).

Alternate delegate to the CMA House of Delegates, 2015-2016.

American College of Radiology – Member Economics Committee, Government Relations Committee, Coding and Nomenclature Committee; Member Executive Board California Radiological Society. Society of Nuclear Medicine and Molecular Imaging – Member Government Relations Committee; Past President Northern California Chapter. Experience in private practice, community health, and academic health system settings, Managed operations, personnel and resources in inpatient and outpatient clinical enterprises. Leadership roles held at Sutter Medical Group, Radiological Associates of Sacramento Medical Group, and UCSF.

I have studied health economics and health policy both as an undergraduate and following residency during a fellowship at Stanford, where I earned a Master of Science in health services research. This background has provided me an in-depth education in the complexities of health care delivery and how policy can affect our work as physicians.

I am part of the California HealthCare Foundation Leadership Program, working with health care leaders to improve health care across California. I actively partake in various committees, both within my organization and externally—championing clinical quality improvements, work flow efficiencies, and team-based approach to clinical care. I am an active member of the Practice Improvement Project Advisory Board for SFHP and serve as a clinical ambassador to SFGH in improving communication and work flows between our respective organizations.

Alongside powerful advocacy, SFMS can further guide healthcare’s evolution locally as patients are segmented into competing systems employing increasing numbers of SFMS members. I aim to contribute to the development and implementation of strategies extending SFMS value and visibility alongside increased physician influence and connectivity in this evolving healthcare environment.

I enjoy both clinical medicine and populationbased interventions that influence health. I would be honored to serve another term on the Board of Directors.

The importance around educating and galvanizing our colleagues and community has never been more paramount given the changes with ACA Healthcare Reform and continued attacks on physician autonomy. With my dynamic background, I aspire to empower physicians to build a more united and informed medical community in our local area.

SFMS/CMA Committees or Offices

Additional Relevant Experience

Why Are You Interested in Serving?

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OCTOBER 2015 SAN FRANCISCO MEDICINE

CANDIDATE BIOGRAPHIES Board of Directors RAYMOND LIU, MD

TODD A. LEVINE, MD, MS

Internal Medicine

Hematology/Oncology

HEYMAN OO, MD, MPH

Pediatrics

Current Job Positions and Hospital and Teaching Affiliations

Hospitalist; The Permanente Medical Group, San Francisco. SFMS/CMA Committees or Offices

None

Chief of Hematology / Oncology, Kaiser San Francisco; Chief of Health Education, Kaiser San Francisco; Committee Member - Community Benefits, Kaiser San Francisco; Smoking Cessation Champion, Kaiser San Francisco.

UCSF/SFGH Pediatrics Leadership for the Underserved (PLUS) Resident, PGY-2.

None

I am a graduate of Harvard University, having received my training in internal medicine / hematology / oncology at UCSF. I serve on the Community Benefits Committee at Kaiser San Francisco to provide grants to organizations that seek to improve the health of the San Francisco community. My work as Chief of Health Education also helps bring patient education and outreach to the community.

As a medical student, I became involved in organized medicine through a health policy course taught by a former CMA President. We learned local advocacy techniques, media skills and went to Sacramento to lobby with the San Diego County Medical Society (SDCMS) and the CMA. Eventually, I served as a student member for the Board of SDCMS for 3 years, attending political candidate interviews and participating in their advocacy deliberations.

I am passionate about patient advocacy and preventive care, having championed health education and smoking cessation at Kaiser San Francisco. I plan to bring my activism in these areas to help shape health policy in San Francisco.

As a physician trainee, it is important to remember that I must advocate for my patients in clinic, but also advocate for them in the larger society. Serving as a Board Member would empower me to be both a bigger picture advocate and share that valuable perspective with my coresidents.

Additional Relevant Experience

The majority of my professional time is spent in hospital administration. Over the last 10+ years I have provided oversight for both inpatient and outpatient Quality programs, Resource Stewardship, Risk/Medical-Legal Affairs, Graduate Medical Education and Professional Staff functions including survey readiness.

Why Are You Interested in Serving?

After nearly twenty years in practice, all in San Francisco, I have amassed the clinical and administrative experience to serve as an effective advocate for both the clinicians and patients of San Francisco County. The SFMS is a perfect avenue to both improve health care services to all citizens of San Francisco as well as advance my own interest in health care policy and advocacy. It is an honor to be considered to serve on the Board and look forward to the opportunity. 24

SAN FRANCISCO MEDICINE OCTOBER 2015 WWW.SFMS.ORG

MONIQUE D. SCHAULIS, MD, MPH

DAVID R. PATING, MD Incumbent Director

KORY D. STOTESBERY, DO

Also Candidate for Young Physician Section Delegate or Alternate

Psychiatry/Addiction Medicine

Emergency, Hospice and Palliative Medicine

Child Psychiatry

Current Job Positions and Hospital and Teaching Affiliations

Chief, Addiction Medicine/Chief, Physician Wellbeing, Kaiser San Francisco Medical Center; Assistant Clinical Professor, UCSF; Fellowship Site Director-Addiction Psychiatry.

Senior Emergency Physician, Kaiser San Francisco. Teach UCSF Emergency and Kaiser Internal Medicine residents.

Seneca Family of Agencies and Private Practice in San Francisco and Walnut Creek.

SFMS: Board of Directors 2013-2015; Psychiatry Committee (consultant), Journal Guest Editor and Contributor, Editorial Committee (2015), Daniel Perlman Journalism Award (2011); CMA: Delegate 2014-2015; Marijuana Regulation TAC (2011), CMA Gary Nye Award for Physician Health and Wellbeing (2011); Committee on the Medical Board (2009).

None

I have been part of the SFMS Membership Committee this past year.

Health Commissioner, City and County of San Francisco (appointed 2014); Advisor, San Francisco Department of Public Health (Healthy San Francisco Program, Mental Health Services Act, and Suicide Prevention Taskforce); Vice Chair, California Mental Health Oversight and Accountability Commission (Prop. 63) (2007-2014); Chair, California Coalition on Whole Health (MH/ SUD coalition on implementation of CA Health Exchange); Board Memberships: CHA-Behavioral Health Board, CPA-Government Affairs, CSAM/ASAM-Executive Councils, CPPPH-Board, National Quality Forum-Behavioral Health Steering Committee; Past Advisor to Medical Board of California, Diversion Program .

I am not in the habit of running for elected office. Currently, I am the treasurer of the Kaiser SF Emergency Department and our opioid champion. Outside the ER, I am working on creating EM Talk, a curriculum focused on communication skills in the Emergency Department. I also am part of our new palliative care home visit program. I have volunteered for Health Right International, Doctors of the World, and Project Homeless Connect.

For the past 2 years I have been a member of the Executive Board for the Northern California Regional Organization of Child and Adolescent Psychiatry. I was recently elected to be president of the organization in 2016.

SFMS is a vibrantly influential leader in health policy. Whether through our far-reaching journal, SFDPH collaborations, or progressive CMA resolutions promoting reform in health care, SFMS is a winner. As a San Francisco City and County Health Commissioner, I am intimately aware of the importance of physician leadership in developing good health policy. From the promotion of non-sugary beverages to the regulation of e-cigarettes, SFMS has lead our city and state to improve the health of our whole community. Who could resist this opportunity to serve?

Trained in Emergency Medicine, Hospice/ Palliative Medicine, and Public Health, I find myself uniquely positioned in the current healthcare debate of how to provide high quality, accessible, and humane medical care at an affordable cost. Advocacy and policy work are critical means to achieve change. I hope to participate via SFMS.

As an early-career physician and a psychiatrist, I hope to bring valuable perspectives to the SFMS Board of Directors. Mental health, particularly for youth, has become an important topic in our society. I am excited about the prospect of representing those interests and assisting SFMS to be a leader in this front.

SFMS/CMA Committees or Offices

Additional Relevant Experience

Why Are You Interested in Serving?

WWW.SFMS.ORG

OCTOBER 2015 SAN FRANCISCO MEDICINE

CANDIDATE BIOGRAPHIES SFMS Board of Directors

SFMS Nominations Committee MABEL A. CHAN, MD

WINNIE TONG, MD

Plastic Surgery

Pediatrics

ALICE HM CHEN, MD

Internal Medicine

Current Job Positions and Hospital and Teaching Affiliations

I am currently a plastic surgeon at Kaiser Permanente Medical Center at San Francisco and have no current formal teaching affiliations.

Assistant Clinical Professor of Pediatrics at UCSF. Currently works in primary care, urgent care and as a pediatric hospitalist at San Francisco General Hospital (SFGH). Medical Director of Inpatient Pediatrics at SFGH.

Chief Medical Officer, San Francisco Health Network. Professor of Medicine, University of California San Francisco. Primary care physician, Richard H Fine People’s Clinic, San Francisco General Hospital.

SFMS/CMA Committees or Offices

None

Additional Relevant Experience

None

I served as Resident Representative to the American Society of Plastic Surgeons (ASPS)/ Plastic Surgery Foundation (2013-14) and the ASPS Government Affairs Committee. Active involvement in the ASPS Young Plastic Surgeon Steering Committee provided insight into concerns of new surgeons. I also provided leadership in creating and managing a forum used to improve education and communication for plastic surgery residents. Active listening to peers and staff keeps me informed of current workplace and community issues.

Involvement in multiple hospital committees at SFGH and interactions with multiple different departments and specialties at SFGH.

Over the last decade I’ve held a series of physician leadership positions at San Francisco General Hospital including Medical Director of the General Medicine Clinic, Director of eReferral, and Chief Integration Officer. At UCSF, I led the development of a policy and advocacy curriculum for SFGH based residents. Prior work in language access and cultural competency involved close partnerships with the California Academy of Family Physicians and ACCMA, among other professional medical societies.

I strongly believe in continuous education/ improvement in the medical field and the SFMS Board can provide the platform to launch improvements. Furthermore, I can provide energy, enthusiasm, and leadership in programs for orienting physicians to an environment demanding high quality care and continuous education.

I currently work with multiple disciplines to help advance the care of children at SFGH. I am interested in becoming more involved with the medical community of San Francisco and look forward to meeting and working with other physicians to help advance the care of the citizens of San Francisco.

SFMS’ policy priorities are very much aligned with the public and population health needs of our City. As a member of the Nominations Committee, I would take seriously the responsibility of identifying and recruiting a diverse set of talented leaders to further SFMS’ agenda.

Why Are You Interested in Serving?

SAN FRANCISCO MEDICINE OCTOBER 2015 WWW.SFMS.ORG

FUNG LAM, MD

DAVID T. DUONG, MD, PHD

Urology

DAWN D. OGAWA, MD

Obstetrics and Gynecology

Current Job Job Positions Positions and and Hospital Hospital and and Teaching Teaching Affiliations Affiliations Current

Urologist in private practice; Active medical staff member at California Pacific Medical Center, Saint Francis Memorial Hospital, and St. Mary’s Medical Center.

SFMS/CMA Committees or Offices

Senior partner at Golden Gate Obstetrics and Gynecology in San Francisco. 2015 marks my 30th year of practice at CPMC. Currently a Clinical Professor in Obstetrics and Gynecology at UCSF and the Dartmouth Geisel School of Medicine. I am a member of the Medical Executive Committee at CPMC.

Practicing Obstetrician and Gynecologist (2008-present), Chief of Patient Health Education, Assistant Chief of Obstetrics and Gynecology Kaiser Permanente San Francisco; Volunteer Clinical Faculty at UCSF (2008 – present); San Francisco Gynecology Society Member; ACOG Resident Lobby Day Leader, American Congress of Obstetricians Gynecologists (2012-15). None

None

Currently serve on Board of Directors of Saint Francis Memorial Hospital

Throughout my professional career, I have strived to maintain the highest standards of clinical care, continue self-education and the education of others, improve the quality of care provided and perform clinical research. In addition to clinical, research and teaching responsibilities, I have been a long-time advocate for women’s health care and have held leadership positions in the American College of Obstetricians and Gynecologists, served as President of the San Francisco Gynecological Society, and am currently Secretary-Treasurer of the Pacific Coast Obstetrical and Gynecological Society.

Through my training at UCSF, as a member of the SF Gyn Society and as a practicing physician at Kaiser Permanente I know many physicians across medical centers and across specialties. Knowing this community of doctors will make me a valuable member of the nominations committee. It is critical that our voice is heard here at City Hall and in Sacramento as policy decisions are made.

When I began practice in 1985, my mentorGilbert A. Webb, instilled in me the duty to serve not only my patient population, but also the hospital and the greater community. Many of the capable group of physicians who have led to this point are approaching retirement. With younger physicians choosing not to participate as readily, I fear that there will be a dearth of physician leaders. I have taken the pathway of active participation and leadership in my practice, at CPMC, in our community and on a national level. I feel this experience will make me well suited as an active participant on the Nominations Committee and also allow me to be a mentor for those new to the process. I look forward to the opportunity to help shape the future leadership of the San Francisco Medical Society.

I am impressed by the work SFMS has done to improve the overall health of residents in San Francisco and California through political action. I would welcome the opportunity to be more involved in this work as a member of the Nominations Committee.

Additional Relevant Experience

Why Are You Interested in Serving?

I would be honored to serve on the Nominations Committee to recruit new talent to help lead the San Francisco Medical Society. Together, we must work to improve the health of our patients and our practices.

WWW.SFMS.ORG

OCTOBER 2015 SAN FRANCISCO MEDICINE

CANDIDATE BIOGRAPHIES American Medical Association Delegate

American Medical Association Alternate Delegate

SFMS Young Physicians Section (YPS) Alternate or Delegate to the CMA House

GORDON L. FUNG, MD, PHD, FACC, FACP

ROBERT J. MARGOLIN, MD Incumbent Delegate

MARK A. SCHRUMPF, MD

Incumbent Alternate

Also Candidate for Editor

Internal Medicine and Geriatrics

Cardiology

Orthopedic Surgery

Current Job Positions and Hospital and Teaching Affiliations

Primary Care Practice in Internal Medicine; Chief, Division of Internal Medicine at CPMC; Vice Chief of Staff of the Medical Staff at CPMC; Chair of the Credentials Committee at CPMC; Board of Directors, Medical Insurance Exchange of California; Associate Clinical Professor, UCSF.

See bio under Editor.

Attending Staff at the San Francisco Shoulder Elbow and Hand Clinic at California Pacific Medical Center.

SFMS/CMA Committees or Offices

AMA: Delegate to the House of Delegates; CMA: Past Member of the Board of Trustees, Past Chair of the Audit Committee, Chair of CALPAC; SFMS: Past President, Past Chair of the Delegation.

None

I have spent much of the past twenty years in leadership roles in our medical society and the CMA.

I am a young physician recently returned to my native Bay Area to practice. Since my return, I have partnered within my hospital to help organize efforts across the system for recent EHR rollouts and other hospital initiatives. This exposure has piqued my interest to continue to work with my fellow physicians to ensure that we are continuing to provide outstanding care.

Additional Relevant Experience

Why Are You Interested in Serving?

I have greatly enjoyed my role as your AMA delegate for the past eight years. I believe I have the experience, perspective, energy, and desire to continue to advocate for physicians and their patients and thus ask that you reelect me to serve as your AMA delegate.

Over the past two years, I have served as an alternate delegate from the San Francisco Medical Society and CMA to the AMA. The experience was highly stimulating and provocative. Representing San Francisco and California in one of the largest organized medicine institutions and facilitating our impact on the practice of medicine in America was just awe-inspiring. The AMA is involved in every aspect of medical care from the training of students and residents to the regulation of the medical practice including ethical practice and government reimbursement. I seek re-election as alternate delegate to continue the great work that we are doing at SFMS to the national level.

This is an opportunity to help move health care forward in a rapidly changing time. As an active participant in my local, regional and national specialty organizations I would like to find a role in the greater medical community to ensure that young physicians have a voice in California.

SAN FRANCISCO MEDICINE OCTOBER 2015 WWW.SFMS.ORG

SFMS Delegation to the California Medical Association House of Delegates

KORY D. STOTESBERY, DO

SHOSHANA R. UNGERLEIDER,

AMEENA T. AHMED, MD, MPH

Incumbent Alternate

Incumbent Delegate

Also Candidate for Board of Directors

Child Psychiatry

Hospitalist, Internal Medicine

Internal and Preventive Medicine

CurrentJob JobPositions Positionsand andHospital Hospitaland andTeaching TeachingAffiliations Affiliations Current

I live in San Francisco and work as an internal medicine hospitalist at John Muir Medical Center in Walnut Creek, California.

Adult Medicine, Kaiser Permanente San Francisco Medical Center; Chief of Complementary and Alternative Medicine; Assistant Clinical Professor, Department of Epidemiology and Biostatistics, UCSF.

SFMS Young Physician Section Alternate to the CMA House of Delegates, 2014-2015.

CMA Delegate 2014-2015; Former SFMS PAC Board Member.

I have served as the Northern California delegate to the national assembly for the American Academy of Child and Adolescent Psychiatry for the past two delegations. As a representative, I have helped propose action statements to promote ethical publication of research, establish official recommendations for homeschooling, and explore ways to reorganize the organization to promote efficient advocacy and transparency. I also organized a well-attended advocacy day in Sacramento for child psychiatrists.

I initiated a comprehensive palliative care education program for the residents at California Pacific Medical Center and serve as an advisor for the program. In medical school at Oregon Health and Science University, I served as Vice President of the American Medical Student Association chapter. I also served on the Student Health Advisory Committee Member at the University of Oregon.

I completed a fellowship in social epidemiology, through which I developed a keen interest in how political and social factors affect health. This background has demonstrated to me how important policy is in shaping health and health care. Iâ&#x20AC;&#x2122;ve had the privilege to volunteer with Physicians for Human Rights in Central Asia, the Middle East, and South America, working to end human rights abuses and create mechanisms for accountability.

There are many hurdles the mental health field needs to overcome to be able to provide people with the care that our community needs. Being a delegate with SFMS would allow me the opportunity to work toward making those changes and to learn how to be a more effective advocate.

I enjoyed serving as the Young Physician Section Alternate to the CMA House of Delegates last year and learned more about the health care policy process and how the CMA advocates for patients, physicians, and the best practice of medicine in California. I have a personal passion for issues surrounding graduate medical education and end-of-life care of patients. I look forward to serving again.

I look forward to serving San Franciscoâ&#x20AC;&#x2122;s physicians as a leader and advocate. I would be honored to work with my colleagues to shape policy to improve health in San Francisco.

See additional bio under Board of Directors.

SFMS/CMA Committees or Offices

None

Additional Relevant Experience

Why Are You Interested in Serving?

WWW.SFMS.ORG

OCTOBER 2015 SAN FRANCISCO MEDICINE

CANDIDATE BIOGRAPHIES SFMS Delegation to the California Medical Association House of Delegates ROGER S. ENG, MD, MPH, FACR

CHARLES E. BINKLEY, MD

Incumbent Delegate

GEORGE A. FOURAS, MD Incumbent Delegate

Also Candidate for Board of Directors

Surgery—Hepatobiliary and Pancreatic

Radiology

Child/Adolescent Psychiatry

Current Job Positions and Hospital and Teaching Affiliations

See bio under Board of Directors.

President, Golden Gate Radiology Medical Group; Chief of Radiology, Chinese Hospital.

Psychiatry Consultant, Human Services Agency; Staff Psychiatrist, Special Programs for Youth/Juvenile Justice Center/Dept. of Public Health, City and County of San Francisco.

SFMS: President 2015; Director 2009–12; Executive 2010–11, 2013-present; PAC 2011–present; Nominations 2011; CMA: Board of Trustees 1997–98, 2003–07; Delegate/Alternate Delegate 1995–present; Young Physicians Section, Chair 2001–02; IT Committee, Chair 2004–08; Committee on Nominations 1997–98, 2003–07; LongRange Planning Committee 2003–07; Chair, CMA Website 2006–07; Health Care Finance Technical Advisory Committee 2004; Committee on Medical Service 1998–99; CMA House of Delegates 2012 Reference Committee C Chair (partial list).

SFMS Consultant to Board, 2013-present; Immediate Past President, 2012; President, 2011; President-Elect, 2010; Secretary, 2009; Director, 2003-08; Executive Committee, 2003-11; SFMS PAC, 2004-present (Chair 2015 + 2007-08); Physician Membership Services, 2003-present; CMA Delegate, 2010-16; CMA Alternate Delegate, 2007-09, 2000-02.

AMA offices: AMA Delegate 1996–97; AMA-RPS Delegate 1995–97; AMA-YPS Delegate 1998–99 (Vice Chair, CMA YPS delegation); Related medical affiliations: President, California Radiological Society; Treasurer, San Francisco Bay Radiological Society; Kona Healthcare, Chief Medical Officer; Chinese Community Health Care Association IT Committee 2006– present; Carestream Physician Advisory Board 2005–present; American College of Radiology, Councilor, 2008–present; Chinese Hospital, Medical Executive Committee 2004–2010 .

Past President, NC Regional Organization of Child and Adolescent Psychiatry; Co-chair, Adoption and Foster Care Committee for the American Academy of Child and Adolescent Psychiatry

Participating in our local medical society is both a privilege and a professional responsibility. I will continue to represent our diverse membership and public health initiatives at the state level.

The SFMS delegation has been one of the most influential groups in the CMA. It has been an honor to participate and to encourage younger physicians to become engaged in organized medicine. I hope that you will allow me to continue to serve the SFMS in the future. Thank you for your support.

SFMS/CMA Committees or Offices

Additional Relevant Experience

Why Are You Interested in Serving?

I believe that I can represent the unique concerns and needs of San Francisco’s physicians to the CMA. In particular, I have an interest in ethical issues that physicians face and look forward to aid forming sound policy which will guide decision making. I will effectively contribute to thoughtful conversation and negotiation in representing San Francisco physicians to the CMA. 30

SAN FRANCISCO MEDICINE OCTOBER 2015 WWW.SFMS.ORG

BRIAN GRADY, MD

KATHERINE E. HERZ, MD, MS

SINDHURA KODALI, MD, MPH

Incumbent Delegate

Also Candidate for Board of Directors

Urology

Emergency Medicine

Pediatrics

Why Are You Interested In Serving? Current Job Positions and Hospital and Teaching Affiliations

Urologist, Golden Gate Urology; active medical staff member at CPMC and CPMC/St. Luke’s, St. Mary’s Medical Center, St. Francis Memorial Hospital, and Seton Medical Center.

See bio under Board of Directors.

Second Year Pediatrics Resident, UCSF Benioff Children’s Hospital. Medical school at the University of Michigan Medical School, Masters in Public Health at Harvard School of Public Health. Bachelor of Arts in Asian and Middle Eastern Studies at Dartmouth College.

SFMS/CMA Committees or Offices

SFMS Board of Directors, Liaison from St. Luke’s Medical Staff to the SFMS; member of the Executive committee.

None

Additional Relevant Experience

Currently serving as the Chief of Surgery Department, CPMC/St. Luke’s campus; former president of the CMA Resident Physician’s Section; delegate to the AMA HOD and CMA HOD, Resident and Student sections.

I held several elective offices and leadership positions in medical and graduate school, serving as an advocate for my patients and community. I was particularly active in the immigrant community, serving as Co-president of the South Asian Medical Students Association and Regional Co-Director for the Asian and Pacific American Medical Students Association through which I promoted dialogue about key health issues in the community by organizing our regional conference and several workshops and health fairs.

Why Are You Interested in Serving?

I am grateful for the opportunity to serve my colleagues thus far; I hope that I am allowed to build on my experience and continue to participate during this fascinating and challenging era of medicine. Thank you for your consideration.

WWW.SFMS.ORG

I enjoy both clinical medicine and population-based interventions that influence health. I would be honored to serve as a delegate to the CMA House of Delegates, where I believe we have many opportunities to help shape both debate and policy around health care.

I want to serve as your representative to the CMA House of Delegates because I believe advocacy on behalf of patients and colleagues is fundamental to a physician’s work. My experience as a community organizer advocating for diverse patient needs will help me identify and review important policy initiatives.

OCTOBER 2015 SAN FRANCISCO MEDICINE

CANDIDATE BIOGRAPHIES SFMS Delegation to the California Medical Association House of Delegates STEPHANIE OLTMANN, MD

KEITH E. LORING, MD Incumbent Alternate

Emergency Medicine

Family Medicine

JUDY L. SILVERMAN, MD Incumbent Alternate

Physical Medicine and Rehabilitation, Pain Medicine

Current Job Positions and Hospital and Teaching Affiliations

Primary Care Physician at Dignity Health Foundation Group, St. Mary’s Medical Center and USF Student Health Center.

Private practice, St. Mary’s Spine Center, California Preferred Medical Associates, member of the board.

Board of Directors 2011-15 and 2009; SFMS Treasurer 2010; Alternate Delegate to CMA House 2011-13; Delegate to the CMA House 2014; Finance Committee 2010-13; Executive Committee 2009-11.

Board of Directors 2015-2017; Executive Committee 2015; Young Physician Section Delegate to CMA House of Delegates 20142015, Alternate Delegate to CMA House 2013.

Alternate Delegate to CMA, 2010-2011, 20132014.

SF DPH Psychiatric Crisis SOC Committee Member, 2011 to 2014; SF DPH Dore (Psychiatric) Urgent Care Center Steering Committee, 2007-2011; SF Emergency Physician Association President, 2009-2010; Reference Committee Member, CMA House of Delegates, 2011-2012; Vice Chief of Staff at St. Mary’s Medical Center, 2008-2010; Regional Medical Director, California Emergency Physicians, 1/2008 to 8/2010.

Co-Chief and Chief in family medicine residency program at North Shore – LIJ Health System, Glen Cove, NY; Resident Delegate to the Congress of Delegates for the NY State Academy of Family Physicians during second and third year of residency

I want to be a part of the answer to the evolving challenges currently posed by the implementation of the Affordable Care Act, the ethical issues surrounding end of life care and the exploration of alternative approaches to individual and public health. Therefore, I value greatly the opportunity to participate with our delegation to the CMA HOD and ask the membership to allow me to continue to do so.

Serving as a member of the San Francisco delegation to the CMA HOD has been a privilege and an honor to me for the past 2 years. It has been a wonderful learning experience and a great opportunity to participate in the making of health policy at its roots, and in a time of significant changes in health care and of rapidly evolving technology, I am looking forward to further engaging in the process of health care reform and policy.

Attending Emergency Physician, Emergency Department, CPMC Davies Campus.

SFMS/CMA Committees or Offices

Additional Relevant Experience

Why Are You Interested in Serving?

When all is said and done, the ultimate core of practicing medicine is the relationship between doctor and patient. When in an exam room with a patient, there are 2 people to attend to; the patient and the doctor. Both need to understand and be comfortable with the proposed treatment plan. We are in a time of change. As a physiatrist, I approach patient care from a multidisciplinary perspective, integrating psychological and social issues with the medical condition. At the CMA House of Delegates, this ability to integrate allows me to help develop policy that unites the concerns of physicians and patients advancing the goals of the CMA.

SAN FRANCISCO MEDICINE OCTOBER 2015 WWW.SFMS.ORG

Tracy Zweig Associates DARIA L. THOMPSON, MD, MPH

INC.

REGISTRY

PLACEMENT

FIRM

~ Physicians ~ Pediatrics I currently work as a PGY-3 Pediatric Resident, training at University of California San Francisco. I spend my days in a variety of clinical settings - in a tertiary care academic setting, in a large managed care organization, and in a public hospital and trauma center. None

This year, I joined the SFMS to attend the CMA Legislative Advocacy Day. Alongside other members, I met with San Francisco Senator Mark Leno and Assemblyman David Chiu. In addition, I was able to present the details of SB277 (Personal Belief Exemptions) to the legislators. Finally, as part of obtaining my Master’s in Public Health, I have a background in ethics, law, and policy issues in medicine. After attending Advocacy Day, I was inspired by our impact—for example, SB277 passed out of the Assembly Healthy Committee—and I looked for a way to become more involved. As a delegate to the CMA, I can represent my city and its children on matters of public health and policy.

Nurse Practitioners Physician Assistants

Voice: 800-919-9141 or 805-641-9141 FAX: 805-641-9143 tzweig@tracyzweig.com www.tracyzweig.com

Attorneys representing doctors, their patients, families, and friends to obtain their disability insurance and other insurance coverage beneﬁts.

LAW OFFICES OF S.F. Medicine MANN LAWRENCE 02-20-14 (855) 592-7664

LarryMann@TheDisabilityInsuranceSite.com

ICD-10: Making the Transition Kimbelee Snyder Overview ICD-10 code sets will replace ICD-9 on October 1, 2015. Everyone covered by HIPAA is impacted by this change in code sets. • Claims for services provided on or after October 1, 2015 should be submitted with ICD-10 diagnosis codes. • Claims for services provided prior to October 1, 2015 should be submitted with ICD-9 diagnosis codes. • Changes to ICD-10 does not affect CPT coding for outpatient procedures. In order to effectively transition to ICD-10, providers should note the following differences between ICD-9 and ICD-10 and staff should be trained to ensure compliance with the new coding system. Other Changes to Note in ICD-10-CM: • Importance of Anatomy: Injuries are grouped by anatomical site rather than by type of injury • Incorporation of E and V Codes: The codes corresponding to ICD-9-CM V codes (Factors Influencing Health Status and Contact with Health Services) and E codes (External Causes of Injury and Poisoning) are incorporated into the main classification rather than separated into supplementary classifications as they were in ICD-9-CM • New Definitions: In some instances, new code definitions are provided reflecting modern medical practice (e.g., definition of acute myocardial infarction is now 4 weeks rather than 8 weeks) • Restructuring and Reorganization: Category restructuring and code reorganization have occurred in a number of ICD-10-CM chapters, resulting in the classification of certain diseases and disorders that are different from ICD-9-CM • Reclassification: Certain diseases have been reclassified to different chapters or sections in order to reflect current medical knowledge

Claims Submission

Providers should submit all claims with ICD-10 codes as of October 1, 2015. Claims for patient encounters prior to that date can be submitted using ICD-9 codes. CMS will not be denying claims based on specificity of codes as long as providers use the code from the right family. This policy is in effect until September 30, 2016 at which time claims will need to have specific ICD-10 codes. Please note that claims can be chosen for review for other reasons.

Not Ready?

Providers that are having delays implementing ICD-10 have the following options to consider: • Free Billing Software and Provider Internet Portals—offered at https://www.cms.gov/Medicare/Coding/ICD10/Downloads/Contractors-ICD-10-Claims-Submission-Alternatives-Web-Pages.pdf. These options apply to Medicare claims only. • Paper Claims—In some cases you may be eligible to use paper claims to meet the ICD-10 requirements. You can apply for a waiver of the Administrative Simplification Compliance Act (ASCA) by visiting the CMS website. The following requirements must be met to qualify for a waiver: WWW.SFMS.ORG

• Software vendor is not ICD-10 ready • Your MAC’s providers internet portal does not support electronic claims submission

In either of the above scenarios you must prove financial hardship to switch vendors or billing services and provide the following: • Vendor letter stating their software is not ICD-10 compliant, OR • Attestation from provider stating that the software in use is not ICD-10 ready; AND • Attestation of provider financial hardship; AND • Acknowledgement that paper claims must be submitted in a machine scannable format.

If a provider qualifies for the ASCA waiver they will be placed on a Corrective Action Plan (CAP) not to exceed d120 days. The provider must also submit a well-documented plan with timelines to become ICD-10 compliant.

Resources

CMS has set up a center for communication and collaboration that began operation at the end of September. The center will identify and initiate resolution of issues providers face during this transition. William Rogers, MD, an emergency physician who heads CMS’ Physician Regulatory Issues Team, is the ombudsman. Rogers will serve as an internal advocate inside CMS and he will take questions and concerns at icd_10ombudsman@cms.hhs.gov. Visit SFMS.org for additional resources, http://www.sfms. org/for-physicians/icd-10.aspx

Kimbelee Snyder is Vice President, Informatics Services at Lumetra Healthcare Solutions. Lumetra has just been awarded a grant from Medi-Cal to help providers with their EHRs and quality measures. Kimbelee has worked as a strategic consultant for state Medicaid programs and has been instrumental in helping over 800 providers and large clinics achieve meaningful use.

Summary of the differences between ICD-9 and ICD-10* ICD-9-CM Diagnosis Codes

ICD-10-CM Diagnosis Codes

No Laterality

Laterality Right or Left account for >40% of codes

No placeholder characters

“X” placeholders

3-5 digits First digit is alpha (E or V) or numeric Digits 2-5 are numeric Decimal is placed after the third character 14,000 codes

Limited Severity Parameters Limited Combination Codes 1 type of Excludes Notes

7 digits Digit 1 is alpha; Digit 2 is numeric Digits 3–7 are alpha or numeric Decimal is placed after the third character 69,000 codes to better capture specificity Extensive Severity Parameters

Extensive Combination Codes to better capture complexity 2 types of Excludes Notes

*Source: http://www.roadto10.org/whats-different/

OCTOBER 2015 SAN FRANCISCO MEDICINE

MEDICAL COMMUNITY NEWS CPMC

Edward Eisler, MD

CPMC’s liver transplant team has the longest run of statistically better-than-expected survival rates for liver transplant recipients of any program in the United States, according to recent national statistics released by the Scientific Registry of Transplant Recipients (SRTR). For three years running SRTR stats confirm that CPMC has the longest run of riskadjusted patient survival rates. Our surgeons performed more than 200 liver transplants during this stretch, and at CPMC, 96.8 percent of liver patients survived one year after transplant, compared to an expected 91.3 percent. Hamila Kownacki, RN, MSHA, has been appointed as the Chief Operating Officer (COO) at CPMC. Ms. Kownacki will have responsibility for all aspects of operations at CPMC’s four hospital campuses. Ms. Kownacki has worked at CPMC and Sutter Health for about fifteen years, including the past seven years as Vice President of Operations and as Chief Administrative Officer of the Pacific Campus. Dr. William Stewart co-founder of CPMC’s Institute for Health and Healing (IHH), announced his retirement in June. Dr. Stewart is a celebrated ophthalmic surgeon whose career spans more than forty years. He has served as chair of the CPMC Department of Ophthalmology and as a trustee of the CPMC Foundation. Since he co-founded the IHH in 1990, it has grown into an internationally recognized center of healing. Researchers at CPMC’s Research Institute and the hospital’s Comprehensive Stroke Care Center are participating in DAWN, an international study assessing the safety and efficacy of endovascular treatment in patients with ischemic stroke. CPMC is the only site in Northern California chosen to participate in this study. The DAWN study looks at other ways to restore blood flow to the brain over much longer time windows including if you ‘wake up’ with your stroke which usually precludes treatment because the time of onset is unknown. 36

SFVAMC

Diana Nicoll, MD, PhD, MPA

Starting in 2010, the Department of Veterans Affairs underwent a system-wide primary care transformation to embrace a more patient centered approach to primary care. With the goals of improving patient satisfaction and outcomes, we embraced the patient centered medical home approach, which in VA we have termed “Patient Aligned Care Team,” or PACT. Primary care is now structured to deliver services based on a core “teamlet” consisting of a Primary Care Provider, an RN Care Manager, an LVN and a clerk. Through ongoing staff education we have been able to clarify and standardize roles within the teamlet, allowing us to provide efficient and coordinated individual patient care as well as proactively identify gaps in in clinical care and intervene. In addition to traditional face to face provider-patient visits, PACTs also deliver care through alternative portals including telephone visits, group visits, email, and home telehealth technology, Beyond the core teamlet, PACTs also integrate other discipline-specific team members including mental health, pharmacy, social work, nutrition, and subspecialty care. Realizing that our Veteran population needs vary, we have developed special population PACTs—teams which are tailored towards meeting the specific needs of our most vulnerable Veterans. Some examples of these teams include Geriatric PACTs, Post-Deployments PACTs, Homeless PACTs, and Spinal Cord Injury PACTs. These teams have enhanced training and resources such as physical and occupational therapy and specific behavioral health specialists, as well as streamlined processes to maximally coordinate care. Here at the San Francisco VA Health Care System, the PACT transformation effort has been supported from the very beginning by a Center of Excellence in Primary Care Education which educates interprofessional trainees to deliver team-based patient centered care. The result is a primary care clinic where all levels of staff and trainees are collaborating regardless of prior professional silos.

Kaiser Permanente Maria Ansari, MD

As the largest medical group in the United States, The Permanente Medical Group (TPMG) is able to leverage its size and expertise to focus all of its efforts on putting patients first. To achieve this and other goals, TPMG works closely with organized medicine and provides support for physicians to become members of their medical societies. Due in part to the medical group’s prepayment system and integrated care model, when TPMG advocates legislatively, it is thru the lens of what is best for patients. Our patient-focused model includes “one-stop” shopping to help our patients avoid extra trips to medical centers, co-pays, and appointments. All departments work together to focus on prevention and wellness by offering same-day screenings, health education classes, and a host of online options for managing health care. Every provider as his or her own web page with both professional information as well as links to information useful to patients seeking wellness information. We encourage our patients to use our on-line resources to make appointments, review results and to ask questions of clinicians. It is also critical to the practice of TPMG physicians that we constantly assess and honor our organization-wide Conflict of Interest policy, so that physicians are providing the best care for patients without being beholden to vendors and contractors. The medical group adheres to the Sunshine Act criteria as set forth in the national health care law, the Affordable Care Act (ACA). Working to improve care now and into the future is essential if we’re to remain leaders in the medical professional. As a medical group, TPMG is committed to promoting the use of technology to improve health outcomes through a balanced and legislatively approved approach. We will continue to assimilate the latest technological advances, keeping the best interest of our patients always in sight.

SAN FRANCISCO MEDICINE OCTOBER 2015 WWW.SFMS.ORG

Saint Francis Robert Harvey, MD

Over the last few months, Dignity Health Saint Francis Memorial Hospital has experienced a growth spurt of sorts in the breadth of services and technologies offered to better serve our patients. In addition to the CyberKnife Robotic Radiosurgery System, which we announced in the last issue of San Francisco Medicine, Saint Francis recently debuted the da Vinci Robotic Surgery System, a state-of-the-art technology used to perform minimally invasive procedures. The da Vinci robot will assist surgeons in gynecologic, urologic, general, and thoracic surgery procedures. The robot features a magnified 3-D high-definition vision system and tiny specialized instruments to help surgeons operate with enhanced vision, dexterity, and control. Saint Francis is pleased to add the da Vinci Robotic Surgery System to its expanding portfolio of innovative technologies available to patients seeking less invasive alternatives to traditional surgery. We are also happy to announce the opening of the Saint Francis Orthopedic Institute on July 1. Led by Nicholas Mast, MD, medical director, the new institute combines many of the services provided by our former Total Joint Center and San Francisco Spine Institute in one centralized location. The goal is to bring the highest level of care for a variety of orthopedic conditions under one roof. The center provides care for hip, knee, and shoulder ailments in a convenient setting with radiology and registration only steps away. Lastly, on July 13 the Saint Francis Memorial Hospital Intensivist Program was launched in close collaboration with the nationally renowned The Intensivist Group (TIG), an affiliate of Sound Physicians. TIG is wellknown for its multidisciplinary team approach to caring for critically ill patients. The program includes a full-time medical director intensivist, two full-time staff intensivists, and up to three part-time intensivists. Our hospitalist team has been caring for the needs of our inpatients for many years. The addition of the intensivists to protect patients in critical care units will bolster our mission of delivering quality patient care at all levels. WWW.SFMS.ORG

St. Mary’s

SPMF

Robert Weber, MD

Bill Black, MD, PhD

Dignity Health St. Mary’s Medical Center is happy to welcome Michael Carter as our new interim president. Mr. Carter joined St. Mary’s on August 17 to replace outgoing President Anna Cheung, who retired last month. Mr. Carter comes to the Bay Area from Edmonds, Washington, and has more than 38 years of experience in the health care industry. He has served in various executive positions in hospitals, including at the CEO level. His experience includes work in many different types of hospitals, including for-profit, not-for-profit, health maintenance organization (HMO), municipal (district), faith-based, secular, rural, urban, free-standing, corporate-owned, and sizes ranging from twentyfive beds to more than 500 beds. He has extensive experience working with governing boards and with physicians and medical groups of all sizes, and enjoys working toward the mutual best interests of all members of the health care team. I know I speak for the entire medical staff in expressing how delighted we are to have Mr. Carter onboard and are grateful to Anna Cheung for a remarkable seven years of leading St. Mary’s Medical Center. Anna Cheung’s outstanding leadership is reflected in the breadth of achievements and notoriety that St. Mary’s Medical Center has received over the years. Most recently, Consumer Reports released ratings on how well hospitals across California and the nation prevent hospital-acquired conditions. In California, St. Mary’s Medical Center was the second highest ranked hospital for safety. In other exciting news, in August St. Mary’s was selected as the film location for training videos by NASA. The videos were filmed in preparation for the Hawaii Space Exploration and Analog Simulation (NASA HI-SEAS IV) Mars “mission.” During the mission, which began on Aug. 28, a physicist, field biologist, doctor, engineer, astrobiologist, and space architect, will live, work, and do research to help prepare for a future Mars mission while living in a dome on the red lava field of the Mauna Loa volcano.

SPMF has a strong tradition of providing neuroscience and psychiatry subspecialty services to the greater Sutter Health family of patients and providers in San Francisco. We offer subspecialty consultation in dementia and brain health, amyotrophic lateral sclerosis (ALS) and other neuromuscular diseases, epilepsy, and movement disorders, as well as forensic, psychosomatic, transplant, acute consult, peri- and post-partum, and child and adolescent psychiatry. We have expanded services with some key program growth over the past few months. Dr. Alireza Atri, a cognitive neurologist, recently joined as the Ray Dolby Endowed Chair in brain health research at the Ray Dolby Brain Health Center. Dr. Atri serves as the director of research and education at the center and is also a senior scientist at the CPMC Research Institute and a visiting scientist at Harvard Medical School. Dr. Michael Ke joined our neurosciences group to augment our stroke and neurocritical care program, now providing telestroke services for approximately twenty community hospitals across northern California. Dr. Elizabeth Kim came on board as a neurohospitalist specializing in inpatient consultations, providing timely care for acute hospitalized patients when many general neurologists are busy with full waiting rooms back in their offices. Dr. Nelli Boykoff also recently joined our neurosciences group to provide headache medicine subspecialty consultation. The management of complex headaches is a subject that many in primary care as well as general neurology often find as frustrating as do their patients. We have also grown our psychiatry program welcoming Dr. Victor Torres-Callazo who adds to our subspecialty expertise in psychosomatic medicine. The new physicians join a medical staff that regularly distinguishes itself in patient care, education and research. Our psychiatrists serve on the faculty of CPMC’s psychiatry residency program, and many of our neurologists are involved in research with the potential of developing therapies for complex diseases and conditions such as epilepsy, movement disorders and ALS.

OCTOBER 2015 SAN FRANCISCO MEDICINE

UPCOMING EVENTS 10/23: Calanchini Lecture: Acute Stroke Management | 8:00 a.m. to 1:00 p.m. | CPMC Davies Campus – Au-

ditorium | CPMC is hosting a half-day workshop on acute stroke management featuring Joey English, MD; Nobl Barazangi, MD; Lewis Leng, MD; David Tong, MD. Physician experts will review the recent landmark discoveries on use and application of stent retrievers in clinical practice, discuss the latest approaches to IV tpa treatment, and provide updates on the latest neurosurgical stroke treatments. The Calanchini Lecture is free of cost and includes complimentary breakfast and lunch. Space is limited and advance registration is required at http://bit.ly/1J8HKau.

10/25: Reception Benefiting Scott Wiener for State Senate | 5:00 p.m. to 7:00 p.m. | San Francisco private resi-

dence | The SFMS Political Action Committee and CALPAC cordially invite you to a reception in support of Scott Wiener’s candidacy for the California State Legislature to represent San Francisco’s 11th Senate District. Scott has been an advocate of medicine, collaborating with the medical society on a variety of issues including the soda tax, vaccination, and preserving access to care and health safety nets in San Francisco. Please RSVP to Celeste Wolter at (347) 527-3368 or celeste@bedford-grove.com.

10/27: Flu and Infectious Disease Forum | 8:30 a.m. to 12:00 p.m. | Koret Auditorium at the SF Public Library, 100 Larkin Street | The San Francisco Department of Public Health is hosting its annual San Francisco Flu and Infectious Disease Forum on October 27. Physicians and other health care professional are invited to attend this free event to learn more about critical updates from experts in the fields of communicable, vaccine preventable, and sexually transmitted diseases. For more information, visit https://fluforum2015.eventbrite.com. 10/29: IMQ Medical Staff Conference | 8:30 a.m. – 4:30 p.m., Embassy Suites LAX Hotel, Los Angeles | Effective medical staff leadership is not easy. Patient-care problems can require thoughtful and sometimes difficult communications with colleagues. Join other medical staff leaders in a one-day learning opportunity that provides a foundation of knowledge, techniques, and best practices to help you succeed. In one day, attendees will gain insights to assist them in successfully leading a medical staff, and in doing so, comply with key accreditation, licensure, and legal requirements. For more information, visit http://bit.ly/1fseILN or contact Leslie Anne Iacopi at (415) 8825167 or liacopi@imq.org. 10/30-31: 2015 Latino Health Conference | Oakland Marriott City Center | The 2015 Latino Health Conference seeks to address health disparities in the Latino/Hispanic community by sharing evidence-based practices and clinical research, promoting diversity in the healthcare workforce, and creating linkages between community health organizations and health care providers. Conference participants will receive evidence based strategies, practice tips, tools, and patient education resources to 38

improve their clinical practice and patient care. Visit http:// latinohealthconference.com/lhc/ for program and registration details.

11/9-10: Transforming Healthcare: Statewide Stakeholder Summit | Sacramento Convention Center | The California Office of Health Information Integrity (CalOHII) is hosting a two-day conference focusing on the impact of personalized medicine on the future of health care. Presenters include national, state, and local healthcare leaders and innovators, as well as people on the front lines who will share their challenges and progress. Visit http://bit. ly/1fsh3WN for event and registration details.

11/17: SFMS Career Fair for Residents/Fellows/ Physician Members | 5:00 p.m. to 8:00 p.m., Level C

Morrissey Hall, 2250 Hayes Street | SFMS will be hosting its sixth annual Career Fair at Morrissey Hall located on the St. Mary’s Medical Center campus. The event is complimentary to residents and fellows from the four San Franciscobased residency programs. This is an excellent opportunity for physicians looking to practice in the Bay Area to network with representatives from a variety of practice types and settings, and for employers to connect with physician job seekers. For event details or to inquire about exhibiting, visit http://www.sfms.org/membership/student-residents.aspx.

11/21: CPPPH Workshop: Evaluation of Health Care Professionals | 8:30 a.m. to 5:00 p.m., Alameda-

Contra Costa Medical Association Office | The California Public Protection and Physician Health (CPPPH) is hosting an one-day workshop for those who request, use, conduct, or report evaluations of health care professionals. Event attendees can receive up to 6.5 AMA PRA Category 1 Credits™/7.0 NAMSS Credits. CPPPH is an independent, non-profit California public benefit corporation established in 2009 to develop a comprehensive statewide physician health program so that California does not remain one of the few states without such a resource. It is a collaborative effort funded by many medical organizations including the SFMS and CMA. Please visit http://bit.ly/1KaVVOa for registration and event details.

1/29/2016: SFMS Annual Gala | 6:30 p.m. to 9:00 p.m., Legion of Honor | Celebrate SFMS’ 148 years of physician advocacy and camaraderie with many of San Francisco’s most influential stakeholders in the medical community! The 2016 Annual Gala will be held at the iconic Legion of Honor. Guests are treated to an exquisite reception with elegant hors d’oeuvres and libations. Richard Podolin, MD will be installed as the SFMS President. Network with colleagues, meet SFMS leaders, and enjoy a private viewing of the Legion of Honor’s collection galleries. Please note this is a memberonly event. Gala tickets will go on sale November 2015.

SAN FRANCISCO MEDICINE OCTOBER 2015 WWW.SFMS.ORG

The CMA/SFMS’s exclusive new Workers’ Compensation program can help your practice save money! Savings

CMA members qualify for an additional 5% discount* on top of Preferred Insurance’s already competitive rates. Preferred’s rates are set for long term consistency, and are managed by focusing on safety and injury prevention, fraud prevention and the control of medical costs for your practice by getting employees back to work as soon as practical.

Service Mercer’s team of insurance advisors is knowledgeable about the needs of physicians and is available to walk you through the application process. Preferred’s claims examiners are experts in helping members with an employee injury or illness claim. Plus Preferred’s payroll management and flexible payment plans help you manage your premiums in the way that works best for you and your practice’s cash-flow needs.

Safety In addition to mandatory CalOSHA information and videos on workplace safety, Preferred’s team of Risk Advisors are available for consultations when you need them. They also have a strong fraud prevention policy and as a California-based carrier, they know exactly what it takes to do business successfully in this State.

Stability Preferred Insurance prides itself on its stability, which includes maintaining some of the best and most consistent pricing available for CMA members. And because of its Medical Provider Network of credentialed medical professionals, claim costs can be closely monitored and managed while providing quality care to injured employees.

Call Mercer today at 800-842-3761 for a premium indication. CMACounty.Insurance.service@mercer.com or www.CountyCMAMemberInsurance.com.

See how CMA/SFMS’s Workers’ Compensation team can help you save! Sponsored by:

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*Most practices will qualify for group pricing and receive the 5% discount; however some practices will need to be underwritten separately when they do not qualify for the special program terms and conditions. A minimum premium applies to very small payrolls.

Mercer Health & Benefits Insurance Services LLC • CA Ins. Lic. #0G39709 • Copyright 2015 Mercer LLC. All rights reserved. • 71384 (10/15) 777 South Figueroa Street, Los Angeles, CA 90017 • 800-842-3761 • www.CountyCMAMemberInsurance.com • CMACounty.Insurance.service@mercer.com

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cpmc.org/cancer